Lung transplantation (LT) remains the only viable therapeutic option for many patients with end-stage lung disease. Over the past decades, the landscape of LT has undergone significant changes. This report presents the first detailed analysis of lung donation and transplantation activity in France.

All single and double LTs performed in France in 2024 were included in this analysis. Data were obtained from the national registry of the French organ procurement organisation, encompassing donor, candidate, and recipient characteristics, as well as post-transplant outcomes.

In 2024, a total of 323 LTs were performed, including 273 from donation after brain death (DBD) and 50 from donation after circulatory death (DCD). This represents an increase from the 288 LTs performed in 2023 but remains below the 2019 level of 384 LTs. The number of DCD procedures doubled compared to 2023, reaching 50, with a lung utilization rate of 90.7%, up from 72.7% in 2023. The primary indications for LT were COPD/emphysema (45.5%) and interstitial lung disease (ILD, 37.6%), while cystic fibrosis (CF)/bronchiectasis accounted for only 4.1% of cases. The median waiting time for candidates was 2.5 months, with a cumulative incidence of transplantation reaching 53% at 3 months, 67% at 6 months, and 81% at 12 months. One-year post-transplant survival was 83.7%, with variations by indication: 89.3% for CF/bronchiectasis recipients, 87.4% for COPD/emphysema, and 80% for ILD. Only 13.7% of candidates were listed under high-urgency status, a decrease from 17% in 2023 and 24.6% in 2022. Over the past five years, the number of CF and bronchiectasis candidates declined from 112 (24%) to 14 (4.1%), while ILD candidates increased from 117 (25%) to 129 (38%).

France’s LT activity shows gradual recovery, primarily driven by increased DCD procedures, which need to be further developed. LT centers must adapt their surgical and medical strategies to address the evolving distribution of underlying diseases leading to transplantation.